2. “Boke” versus Alzheimer’s in Japan: A Story of Cultural Change Wednesday, October 11, 2000

3. Because... w They were the first papers of the semester… w And because of some lack of clarity having to do with our expectations about sources… w Your TA will “up” the grade you received on your first paper.For example: B- will become B B will become B+ B+ will become A- and so forth

4. Diversifying your sources w “Use examples and concepts drawn from the lecture, reading, discussion, and films” w This will mean for all papers: You must refer to reading, plus material from at least one (1) other course-based source (lecture, discussion, film). (This includes the question on “Twilight Years”: referring to some concept or example from either lecture, film or discussion will improve the paper) Beyond these you are welcome to refer to your own experience, web-sites, etc.

5. Page-length w If you are working from a word-processing program, please run a word count and include this number under your name on the first page. w If you are working with a type-writer, please estimate the number of words, using time-honored standard techniques (counting lines on a page, multiplying by average number of words per line). Please include this number under your name on the first page.

6. Make-up times for Sam and Steve’s sections w Sam: M 9:30 changed to Wed (tonight) at 7 pm, Room w Steve: F (Oct 20) 10:40 section rescheduled for Wednesday, Oct 18, at 7 pm, Maxwell 110. (Don’t worry if this is impossible for you. I will post on the web-site a list of all Tas’ section times; those in Steve’s Friday sections may attend one that you can fit into your schedule)

7. Using course web-site w http://faculty.maxwell.syr.edu/burdick/enco unters%202000/syllabus.htm w I am putting up lectures as fast as I can: if hypertext not on he “right” day, you may want to look at the day before or after w Power Point: you can open lectures on any cluster at SU

8. As you leave, please pick up... w Reading guide for next week, on the first set of readings about clitoridectomy w Criteria used in evaluating your papers, due Monday, October 16th

9. The message of this lecture w Conditions or illnesses get labelled w The labels are influenced by cultural values and social needs w The labels have real-life consequences for the person so labelled

10. Frequencies of Alzheimer’s Diagnoses in US and Japan w US 65-74: 3% 75-84: 19% 85 and older: 47% w Japan 65-74: 1-1.5% 75-84: 8% (up from 5 years ago, and rising) 85 and older: 15% (up from 5 years ago and rising) w Why the contrast? Data gathering? Genetics? Evidence that culture may be important

11. What is Alzheimer’s Disease? w Dementia syndrome in elderly memory loss diminished intellectual ability impaired judgment, disorientation w Plaques and tangles discovered by Alois Alzheimer thought to block neural activity w The gravity of AD no cure or prevention known irreversible ends in death

12. Ambiguities in diagnosis and explanation w Not clear what causes plaques & tangles (p & t) w Uncertainty about relation between p & t and syndrome difficult to be sure of presence of p & t before death (even MRIs and CTs not definitive) many cases diagnosed as AD end up being dementias caused by things other than p & t (ended up having no p & t) some not diagnosed with AD end up having p & t

13. Mr Uemoto w 76 years old, ex-civil servant w Lived until recently (now in a nursing home) with son, daughter-in-law, grandchildren w Wandered, lapses of memory w First description: boke w Visit to the doctor, the Alzheimer’s diagnosis, and rejection of it by family

14. What is “boke”? w Mental, physical and social disorientation memory loss and mental disorientation physical decline social offensiveness w Not bed-ridden, or handled by institutionalization w Can be prevented, slowed, and reversed

15. Japanese cultural resonances of the “boke” label, 1 w machizukuri: ideal of contributing to the community, and hitzokuri: ideal of staying fit w Together these add up to: duty to stay fit for good of the community; it is therefore wrong to be resigned about, for example, becoming senile w Reveals the value placed on elders’ contributions to society w Elders expected to fight against becoming senile

16. Cultural resonance of boke, 2 w Anti-fatalism about health and illness All people, including elders, have great deal of control over body and mind Social and institutional support for cultivating self-discipline and staving off the advance of boke: lots of centers that support elderly gateball, sports, athletics, poetry, etc. Therefore: old person expected to work to prevent onset of advanced boke; shameful if one does nothing or fails to prevent boke from advancing

17. Mr. Uemoto’s family situation changes w Economic situation and daughter-in-law’s job w The advance of the boke w New anxieties moral failure of whole family problem of institutionalizing Mr. Uemoto w Return for a new diagnosis: Alzheimer’s

18. The moral and social advantages to the Alzheimer’s label w Moral relieves stress of having been a moral failure w Social Reduces stigma of the nursing home w Alzheimer’s diagnosis a growing adaptation to a society turning to institutionalization of elders?

19. Why is AD diagnosis more frequent in the US? w What values in this society resonate with AD?